Back Pain
Learn more about common pain conditions, their development, and pain mechanisms.
Overview
Back pain is common. In a representative survey on back pain and tension conducted by the Rheumatism League of Switzerland, 88% of respondents reported having experienced back pain or tension in the past 12 months. Of these, 50% experienced it several times a week to several times a month. Women are more frequently affected. Back problems are among the most common health complaints in today’s society. They affect all age groups and are the leading cause of physical disabilities worldwide.
Back pain often appears suddenly, but usually diminishes in intensity and may disappear spontaneously within a few days to weeks without specific therapy. Medically, this is referred to as non-specific lower back pain. However, at least 8% of adult Swiss people suffer from severe and/or long-lasting chronic back pain that can be attributed to a specific cause. These specific causes of back pain should be examined and treated by specialists.
Causes and Diagnostics
The cause of back pain is often difficult to pinpoint. In adults it is usually due to age and/or stress related mechanical, degenerative wear-and-tear of certain anatomical structures of the spine. These degenerative changes are natural but can be responsible for long-lasting and restrictive complaints. Despite careful history and examination, it is often difficult to identify the cause of the pain. Even the most modern of radiological procedures—such as MRI, CT, and PET-CT—do not always provide clarity. The reason for this is that various anatomical structures of the spine wear out over the course of one’s life and can be responsible for the pain. Frequently, degenerative changes of the facet joints and/or intervertebral discs are the cause of the complaints. In addition, there are various other causes of pain, such as irritation of a nerve root (sciatica) or overuse of the back muscles.
Pain Symptoms
The individual complaints, or symptoms, with which patients present to a doctor, depend on the cause. Shooting, stabbing, or burning pains are typical for nerve compression (sciatica) but can also occur less frequently in acute muscle tension and chronically as a sign of facet joint degeneration. The latter can also radiate into the extremity (projected pain), imitating nerve compression, which complicates the diagnosis. If, in addition to the pain, there is also a reduction in sensation and/or strength in the legs, irritation of a nerve root is likely.
Diagnosis
A detailed history and thorough physical examination are essential to make a diagnosis. Imaging procedures (MRI, CT, X-ray) help in certain cases but are not always required. Targeted test injections play a very important role in back diagnostics. Under ultrasound or X-ray control, targeted injections with local anesthetics can be performed. For example, if such a test injection is made in the area of a suspected painful facet joint, it can be checked whether the pain temporarily subsides after the injection. If the reported pain decreases, it can be assumed that the reported pain originates from the affected structure.
Treatment Methods
The treatment of chronic back pain is often complex and differs significantly from the treatment of acute back pain. A single therapy is often not sufficient, which is why good therapy planning is essential. It is helpful when various measures are coordinated. In the treatment concept for chronic back pain, physiotherapy, manual medicine, chiropractic treatments, complementary treatments, medications, and interventions (infiltrations) play a central role. Medications typically include basic analgesics such as NSAIDs, paracetamol, and, if not effective, metamizole. Morphine preparations (opioids) no longer play a role in chronic back pain. Interventional treatment approaches, such as nerve root blocks, thermal ablation of the medial branches of the facet joints, steroid injections of the facet joints, pulsed radiofrequency treatment of the dorsal root ganglion of the spinal nerve, neuromodulative procedures, and surgical measures, can be applied specifically to relieve complaints.
